10D0946831 CLIA NUMBER - PREMISE HEALTH OF FLORIDA MEDICAL, PA

Laboratory Demographics

CLIA Number: 10D0946831

Facility Name: PREMISE HEALTH OF FLORIDA MEDICAL, PA

Facility Address:
3800 CITI HEALTH SERVICES CENTER TAMPA MEDICAL SERVICES - BLDG C
TAMPA, FL
ZIP 33610
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Facility Phone Number: 813 604-4333

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1366029365

Taxonomy: 261QM1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D0946831
LAB Type	Physician Office
Facility Name	PREMISE HEALTH OF FLORIDA MEDICAL, PA
Street	3800 CITI HEALTH SERVICES CENTER TAMPA MEDICAL SERVICES - BLDG C
City	TAMPA
State	FL
ZIP	33610
Phone	813 604-4333
CertificateType	4
CertificateEffectiveDate	6/3/2022
CertificateExpirationDate	6/2/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024